Roberts must weigh medication, side effects

August 1, 2007|By Denise Grady and Lawrence K. Altman, the New York Times

Despite his quick recovery from the seizure he suffered Monday, Chief Justice John Roberts faces a complex diagnosis and a difficult decision.

Because the seizure was his second -- he had a similar one in 1993 -- he meets the criteria for epilepsy, and he and his doctors will have to decide whether he should take medication to prevent further seizures, according to neurologists not involved in his care. Neither the chief justice nor his doctors would comment Tuesday.

The decision would involve weighing the risk of more seizures against the risk of side effects from the drugs. Major seizures can be a frightening and traumatic experience for both patient and family. Patients are advised to avoid heights and not to swim alone, and many states ban them from driving until they can provide proof that the disease is under control.

But the drugs can have troubling side effects, including drowsiness or insomnia, weight loss or weight gain, skin rashes, irritability, mental slowing and forgetfulness. Many patients can be treated with minimal side effects, doctors say, but it could take trial and error to find the right drug.

The chief justice was released from a hospital in Maine on Tuesday, one day after being rushed there from his summer home because of the seizure.

A statement from the Supreme Court on Monday said that tests at the hospital had found "no cause for concern" and that the cause of the seizure was unknown.

About 2.7 million people in the United States have epilepsy, and in 70 percent of them, the cause is unknown, according to the Epilepsy Foundation.

Neurologists sometimes describe seizures as an electrical storm in the brain, a brief episode of heightened activity that can cause mild symptoms that are barely noticeable, or loss of consciousness and convulsions, as in the case of Roberts.

"If he takes medication, he is likely to do fine and be seizure-free," said Dr. Gregory L. Barkley, a neurologist who specializes in epilepsy and is clinical vice chairman of the neurology department at Henry Ford Hospital in Detroit.

Barkley said he did not expect the illness or the treatment to affect the chief justice's ability to do his job.

But if Roberts' two seizures were 14 years apart, is a third likely, or likely to occur soon enough to warrant taking a drug every day?

Neurologists differ.

"I would recommend taking medication," Barkley said. "The intervals tend to get shorter and shorter, and people tend to have recurrent seizures."

But Dr. Robert S. Fisher, director of Stanford's epilepsy center and a past president of the American Epilepsy Society, said: "In my view, it would be reasonable not to treat. It sounds like he went 14 years between seizures, and that's a lot of pills to take to prevent the next seizure 14 years from now."

Doctors say a complete medical workup is needed to find out whether the two reported seizures were really the only ones that have occurred, because people with epilepsy can have mild seizures that they are not aware of.